Provider Demographics
NPI:1295004026
Name:SCOTT, ROYLENE DEBRA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROYLENE
Middle Name:DEBRA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12523 LIMONITE AVE # 440-403
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3665
Mailing Address - Country:US
Mailing Address - Phone:951-733-2185
Mailing Address - Fax:
Practice Address - Street 1:12523 LIMONITE AVE # 440-403
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-3665
Practice Address - Country:US
Practice Address - Phone:951-733-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor